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Only four people have ever been diagnosed.

Early last year, a 45 year old Indonesian man named Dede Koswara passed away in a hospital in Bali. Dede was perhaps better known as the “Tree Man” — a reference to the 13 pounds of warts that made his hands and feet look like they were covered in bark.

The rare genetic disease that was Dede’s undoing goes by many names: Doctors call it epidermodysplasia verruciformis or Lewandowsky-Lutz dysplasia, but most of us call it simply “tree man illness.”

What is tree man illness?

Tree man illness is a disease that weakens the body’s ability to fight off infections brought on by the human papillomavirus, otherwise known as HPV.

According to the Centers for Disease Control and Protection, HPV is the most common form of sexually transmitted disease and one that almost every sexually active person will contract at some point in their life. There are about 100 types of HPV and around 60 of these cause warts to appear on your hands or feet. There’s no cure for HPV, but a vaccine released in 2006 targets the types of HPV that cause most cases of cervical cancer.

Tree man illness is associated with HPV types 5 and 8. Besides Dede, only three other people have ever been diagnosed.

The man who’s no longer part tree

Abdul Bajandar was only a teenager when the warts began appearing on his hands and feet. As he entered his 20s, the warts began to harden, rendering him incapable of performing everyday tasks, like feeding himself or brushing his teeth.

Unable to afford treatment, Abdul sought help from a television crew that came to his small village in Bangladesh to cover a local election. According to the Washington Post, after showing the crew his hands and feet, Abdul’s story began to spread. Benefactors donated money to help pay his hospital bills; doctors and plastic surgeons at a hospital in Dhaka gave him free treatment.

In 16 surgeries over the course of a year, doctors were able to remove all of Abdul’s warts. Now 27, Abdul is considered to be the first person ever cured of tree man illness — but he’s not out of the woods yet.

Tree roots grow deep

For a time, Dede’s case was looking good. In 2008, 96% of his warts were removed. He was able to wear flip flops and play Sudoku, and dreamed of returning to his work as a carpenter. Then the warts came back, so aggressively that Dede required two surgeries a year to keep the infections at bay. Eventually, the disease overtook him, and he never regained the use of his hands and feet. At the time of his death he was alone, abandoned by the wife and two children he was unable to support.

Abdul is optimistic about his own recovery. Last February he told CNN: “I want to live like a normal person. I just want to be able to hold my daughter properly and hug her.”